Wry Neck (Facet)

Injuries > Neck & Head > Wry Neck (Facet)

(Also known as Acute Wry Neck, Neck Sprain, Facet Joint Sprain, Apophyseal Joint Sprain, Apophyseal Wry Neck, Locked Apophyseal Joint, Zygaphophyseal Joint Sprain, Sprained Facet Joint)

N.B. Although a wry neck may originate from either the discs or facet joints of the neck, the term 'wry neck' will be used in this article to describe a wry neck originating from a facet joint.

What is a wry neck?

A wry neck is a relatively common condition characterized by sudden onset pain and stiffness in the neck or upper back. The injury originates from damage and subsequent 'locking' of one of the facet joints of the neck and results in a noticeable limitation of movement and postural deformity.

The spine (neck) comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally (figure 1). These joints are designed to support body weight and enable spinal movement.

Each facet joint comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the bony joint surfaces, cushioning the impact of one bone on another.

During certain movements of the neck, stretching or compression forces are placed on the facet joint. If these forces are excessive due to too much repetition or high force, injury to the facet joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs and results in a loss of range of movement and postural deformity of the neck the condition is known as a wry neck.

Causes of a wry neck

A wry neck usually occurs either upon waking in the morning or from a sudden, quick movement involving the neck. In the lead up to injury the patient has usually performed activities that involve sustained poor posture, slouching, excessive or repetitive neck movements or excessive lifting. These repetitive or prolonged forces gradually stretch tissue in the neck over time, predisposing the facet joint to injury. A wry neck may also occur due to sleeping in poor posture (figure 2).

Signs and symptoms of a wry neck

Patients with a wry neck typically experience one sided sharp neck pain. There is usually an inability to turn the head to the painful side and often a resultant postural deformity due to pain. The postural deformity is usually positioned with the head tilted away from the side of pain with the patient unable to correct this due to muscle spasm and pain. Occasionally pain may be referred into the shoulder blade, upper back or arm on the affected side. Symptoms are generally exacerbated with activities that involve turning the head to the painful side, bending forwards or sideways, heavy lifting, arching the neck backwards or slouching for prolonged periods (e.g. when sitting – figure 3).

Patients with a wry neck often first notice their symptoms upon waking in the morning. Sometimes there may be no identifiable reason as to why the symptoms have started, although a thorough history and examination from the treating physiotherapist will usually be able to identify the contributing factors.

Diagnosis of a wry neck

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a wry neck. Investigations such as an X-ray, MRI or CT scan may be required to confirm diagnosis.

Treatment for a wry neck

Most patients with this condition heal quickly and have a full recovery with appropriate physiotherapy. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Activities which place large amounts of stress on the facet joint should also be minimized, particularly slouching, excessive neck movements and heavy lifting.

Generally, sitting for prolonged periods should also be avoided. However, if inevitable, optimal sitting posture is vital to minimize stress on the facet joint. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support in the small of your back. Your shoulders should be back and your chin should be tucked in slightly provided there is no increase in symptoms (figure 4).

Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated, whilst maintaining optimal posture, provided there is no increase in symptoms.

Patients should follow the R.I.C.E. Regime in the initial phase of injury. The R.I.C.E. regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime for a wry neck primarily involves resting from aggravating activities and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. When inflammation has settled, heat treatment may be beneficial to reduce muscle spasm and pain associated with this condition.

It is also important for patients to perform early movement, strength and postural exercises to prevent stiffness and weakness from developing and to ensure the neck is functioning correctly. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced.

Prognosis of a wry neck

The recovery time following a wry neck may vary from patient to patient depending on compliance with physiotherapy. Usually the acute symptoms will settle within 2-5 days with appropriate management. With ideal treatment, patients may be pain free in as little as a couple of days, although this may take 2 – 3 weeks. Physiotherapy treatment, however, may be required for a longer period to ensure a full recovery and address any contributing factors such as joint stiffness.

Physiotherapy for a wry neck

Physiotherapy for a wry neck can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:

• traction
• soft tissue massage
• joint mobilization
• ice or heat treatment
• electrotherapy (e.g. ultrasound)
• joint manipulation
• dry needling
• postural taping
• postural bracing
• the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• education
• activity modification advice
• ergonomic advice
• clinical Pilates
• exercises to improve flexibility, strength, posture and core stability

Contributing factors to the development of a wry neck

There are several factors that may contribute to the development of a wry neck. These factors need to be assessed and corrected with direction from a physiotherapist and may include:

• poor posture
• neck joint stiffness
• a sedentary lifestyle
• poor core stability
• muscle weakness or tightness
• inappropriate lifting technique
• a lifestyle or occupation involving large amounts of sitting (particularly at a computer or driving), bending, slouching or heavy lifting

Other intervention for a wry neck

Despite appropriate physiotherapy management, a small percentage of patients with this condition fail to improve and may require other intervention. This may include investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who can advise on any procedures that may be appropriate to improve the condition.

Exercises for a wry neck

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 5 times daily and only provided they do not cause or increase symptoms.

Neck Rotations

Begin sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder until you feel a mild to moderate stretch, or as far as you can go without pain (figure 5). Keep your neck straight and don't allow your head to poke forwards during the movement. Repeat 10 times to each side provided there is no increase in symptoms.

Figure 5 – Neck Rotations (right side)

Chin Tucks

Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 6). Tuck your chin in until you feel a mild to moderate stretch pain-free. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided there is no increase in symptoms.

Figure 6 – Chin Tucks

Shoulder Blade Squeezes

Begin sitting or standing tall with your back straight (figure 7). Squeeze your shoulder blades together as hard and far as possible pain-free. Hold for 5 seconds and repeat 10 times provided there is no increase in symptoms.

Figure 7 – Shoulder Blade Squeezes

Other Exercises

• View more Neck Flexibility Exercises.
• View Basic Pilates Exercises to improve your core stability and posture.

Find a Physio for a wry neck

Find a physiotherapist in your local area who can treat this condition.

Physiotherapy products for a wry neck

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

1. Postural Supports
2. Therapeutic Pillows
3. Ice Packs and Heat Packs
4. Lumbar Rolls for Sitting
5. Sports Tape (for postural taping)
6. McKenzie Treat Your Own Neck Books
7. TENS Machines (for pain relief)

To purchase physiotherapy products for a wry neck click on one of the above links or visit the PhysioAdvisor Shop.

More Information

• Read about improving your Posture.
• Read about improving your Ergonomic Computer Setup to reduce stress on your neck.

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